From the Guidelines
Treatment options for blockages of the meibomian or lacrimal glands should prioritize warm compresses, artificial tears, and eyelid hygiene as first-line therapies, with antibiotic and anti-inflammatory agents considered for persistent cases, as recommended by the most recent guidelines 1.
Overview of Treatment Options
The management of meibomian and lacrimal gland blockages involves a combination of at-home remedies and medical interventions. For meibomian gland blockages, which often cause dry eye and chalazia, the initial approach includes:
- Warm compresses applied to closed eyelids for 5-10 minutes twice daily to melt thickened oils
- Gentle lid massage to express the glands
- Artificial tears 4-6 times daily for symptomatic relief
- Daily lid hygiene using diluted baby shampoo or commercial lid cleansers to prevent recurrence
Medical Interventions
For persistent cases, medical interventions may include:
- Antibiotic-steroid combination eye drops like tobramycin/dexamethasone for 7-10 days
- Oral antibiotics like doxycycline 100mg daily for 1-3 months, which also have anti-inflammatory properties
- In-office meibomian gland expression
- Topical perfluorohexyloctane, which has been shown to improve signs and symptoms of dry eye secondary to meibomian gland dysfunction 1
Lacrimal Duct Blockages
For lacrimal duct blockages causing excessive tearing, gentle massage of the tear sac area and antibiotic drops like moxifloxacin may resolve infection-related blockages. Persistent blockages might require:
- Probing and irrigation by an ophthalmologist
- In severe cases, dacryocystorhinostomy surgery to create a new tear drainage pathway
Considerations
These treatments aim to address the underlying causes of the blockages: melting thickened secretions, reducing inflammation, clearing infections, and restoring normal gland function and tear flow. The choice of treatment should be tailored to the individual patient's presentation and the severity of their condition, considering the level of evidence supporting each option 1.
From the Research
Treatment Options for Blockage of Meibomian or Lacrimal Glands
- The treatment options for meibomian gland dysfunction include conservative measures such as warm compresses and lid hygiene, as well as medical treatments and procedures 2.
- Medical treatments may include antibiotics, nonsteroidal and steroidal anti-inflammatory agents, essential fatty acid supplementation, hormone therapy, and control of Demodex infestation 2.
- Procedures for treating meibomian gland dysfunction include intraductal meibomian gland probing, the use of electronic heating devices, intense pulsed light therapy, and intranasal neurostimulation 2.
Comparison of Treatment Options
- A study comparing oral azithromycin and oral doxycycline for the treatment of meibomian gland dysfunction found that both treatments improved symptoms and signs, but azithromycin had a better effect on improving signs and overall clinical response 3.
- Another study found that topical azithromycin and oral doxycycline both improved tear film thickness and signs and symptoms of ocular surface disease in patients with meibomian gland dysfunction, with no difference between the groups 4.
- A 9-month comparative case series found that oral azithromycin was superior to oral doxycycline in treating meibomian gland dysfunction, with a shorter course of therapy and fewer adverse effects 5.
Management of Blepharitis
- Blepharitis, which can involve the meibomian glands, can be managed with an eyelid hygiene regimen, topical antibiotics, and topical corticosteroid preparations 6.
- Systemic antibiotics may be appropriate in some patients with blepharitis, particularly those with marked inflammation or recurrent episodes 6.
Treatment Considerations
- The choice of treatment for meibomian gland dysfunction or blepharitis depends on the severity of symptoms, the presence of inflammation or infection, and the patient's response to previous treatments 2, 3, 6, 5.
- Patients with meibomian gland dysfunction or blepharitis may require long-term treatment and follow-up to manage their condition and prevent recurrence 2, 6, 5.